Fareni Lifecare Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found 2 breaches of the regulations, as the service was not always providing safe care and treatment to people, and had not checked staff were working safely. The service did not have robust safeguarding processes in place. Care records demonstrated a lack of recognition by the service to identify, review or manage risk. People’s individual risks had not been identified, and thorough risk assessments were not in place to keep people safe. Staff had not received training, and had not been safely recruited. Medicines were not always well managed, and we found medicine errors which had not been identified by the service. Staff administering medicines had not been trained to do so, and their competency had not been assessed. However, people said they felt safe and were happy with the care they received.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people told us they felt safe, we found that not everyone had been assessed as part of their transition into the service. This meant significant risks and peoples individual care needs had not been identified and monitored. Most people did not have a care plan in place. As the service told us they would use peoples care records to communicate information to medical professionals, this placed people at risk of not receiving the care they need. People told us staff communicated appropriately with healthcare services when needed, and they felt confident the service would seek input as required. One person told us "If I am physically unwell they know what to do. If I am mentally unwell they know to contact my Therapist”.

The registered manager told us they were committed to ensuring staff have access to appropriate training and development opportunities. However, staff working at the service did not have access to training at the start of our assessment. The skills and competency of all members of the staff team had not been checked before they delivered care to people. This included training such as moving and handling, medicines and first aid. Staff had not received training to support people with their complex health and care needs. The registered manager arranged for the staff team to receive a limited amount of training in response to our feedback.

Staff had not received training to support people with their complex health and care needs. The registered manager arranged for the staff team to receive a limited amount of training in response to our feedback. A staff member told us they had many years experience of working in care roles, however their competency to deliver safe care had not been assessed by the provider.

Whilst people told us they felt safe, we found that not everyone had been assessed as part of their transition into the service. This meant significant risks had not been identified. Most people did not have a care plan in place. As the service told us they would use peoples care records to communicate information to medical professionals, this placed people at risk of not receiving the care they need. People told us staff communicated appropriately with healthcare services when needed, and they felt confident the service would seek input as required. One person told us "If I am physically unwell they know what to do. If I am mentally unwell they know to contact my Therapist”.

The registered manager did not demonstrate an understanding of how and when to work in partnership with other services. They were unable to provide us with evidence of how they establish and maintain safe systems of care between different services involved in peoples care. There were no processes in place to manage, monitor and assure themselves that peoples safety was being maintained.

The service did not provide any contact details for professionals involved in peoples care. We therefore were unable to seek their views on working with the service. We also had not received any feedback ahead of our assessment.

There were no processes in place for the registered manager to oversee, monitor and assure themselves that peoples safety was being maintained. One staff member told us they had a strong relationship with the local GP surgery. They were able to explain to us how they would make onward referrals appropriately, however evidence to support this process in practice was not available for us see.

People using the service told us they felt the care they received was safe. However, we identified significant risks in relation to peoples health and care needs which had not been identified, assessed or monitored to keep them safe.

The registered manager told us there were no systems in place to monitor peoples safety. However, they told us they intend to implement systems to monitor peoples safety and provide staff with safeguarding training. Without staff having training in safeguarding, the risk of abuse and poor care going unnoticed was increased.

There were no formal processes embedded at the service to ensure peoples safety was assessed and monitored. The registered manager shared a template for recording concerns of a safeguarding nature which they plan to implement. The service told us they have displayed a safeguarding poster in their office, however confirmed staff do not access the office regularly. An incident of a safeguarding nature were identified through the course of the assessment which had not been reported or investigated by the service. The registered manager took retrospective action to safeguard the person.

People told us they felt the staff knew how to provide them with safe care, and that care met their needs. However, peoples health, care, well being and communication needs had not been thoroughly assessed and reviewed. This meant people were placed at risk of receiving care which did not meet their needs. For one person who lived with diabetes, guidance was not available for staff to follow to keep this person safe. There was no information on how the person may present, or the normal range for their blood sugar levels to be. This meant should the persons blood sugar levels be too high or too low, staff may not know the signs to look for, or the correct action to take in response.

The registered manager told us they plan to ensure people have accurate and thorough care records in place, which identify and assess risks relating to peoples care needs. The service shared peoples care records with us which they had reviewed in response to our assessment, however there continued to be significant shortfalls in standards.

The service did not have a process in place for ensuring risks relating to peoples care needs had been identified, assessed and mitigated. The registered manager told us they plan to implement a system for assessing and monitoring risks to peoples safety. This included a monthly review of peoples care needs undertaken by a care supervisor.

People told us staff respected their homes, and they felt safe. All the people we spoke with told us staff always wore aprons and gloves when they were delivering personal care. People told us they had suitable equipment in place to help them mobilise.

The registered manager told us they assess potential risks in peoples homes to ensure the environment is safe. However, we found additional environmental risks which the service had not assessed. This included one person with poor mobility who chose to smoke in bed. Whilst the person told us the measures they had put in place themselves were sufficient, we were concerned that the service had not identified and assessed this risk as well.

Whilst some environmental risk assessments had been completed, these were not robust and failed to identify all potential risks. There was no process for reviewing these risk assessments, and the majority of people using the service did not have one in place at all.

People told us the service always attended calls on time, and staff sometimes stayed longer than their allocated time. People told us they felt confident staff were well trained and experienced. However, none of the staff working at the service had received any training, and the provider had not assessed their skills and competency to deliver a good standard of care before they worked unsupervised. This lack of training, along with the lack of oversight from the registered manager, placed people at significant risk of receiving unsafe care.

In response to our feedback, the registered manager recruited a care supervisor to undertake supervisions and skill checks on staff. Training in moving and handling, medicines management and basic life support was sourced and delivered to staff during the assessment process. The registered manager told us they will continue to train and supervise staff appropriately.

The providers policy stated all staff will receive training, supervision and coaching to ensure they deliver good standards of care. The service was not following their own policy at the time of our assessment.

People told us staff always wore the necessary PPE and kept their environment clean.

The registered manager told us they provide staff with personal protective equipment (PPE) to minimise the spread of infection. The provider had undertaken environmental risk assessments of peoples homes, however these did not fully explore infection control risks, and did not provide sufficient guidance for staff to follow.

Whilst there were processes outlined within the services infection control policy, these was not always being followed. For example, staff had not been provided with training in line with their policy.

The service told us they were supporting only one person with their medicine. However, we spoke with other people using the service who also told us staff supported them with their medicine. Medicine Administration Records (MAR) were only available for one person. Whilst medicines were mostly administered as intended by the prescriber, we identified omissions on MAR chart which could not accounted for. People told us staff supported them appropriately with their medicine, however we were unable to be assured of this as records were not always in place, and details surrounding peoples needs were not reflected within care records. People did not receive their medicines from staff who were trained and deemed competent to administer them safely. No staff had received medicines training at the time of our assessment.

In response to our assessment, the registered manager arranged for staff to receive training in medicines management. They also arranged for staff to receive medicine competency checks, however the person undertaking these checks had also not received training in medicines management themselves. The registered manager told us they would continue to ensure staff are trained and deemed competent to administer medicines to people. The registered manager told us they were implementing weekly and monthly quality checks for medicines in response to our assessment.

The service was not working in line with its own policy for medicines management, and was not following best practice guidelines. The registered manager had no oversight of peoples medicines, and did not undertake any quality checks to assure themselves medicines were being administered safely. This placed people at significant risk of harm should their medicines be incorrectly administered, as there was no process to identify errors in a timely way.